Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, CA, USA.
Gastrointest Endosc. 2012 Jan;75(1):56-64. doi: 10.1016/j.gie.2011.08.032. Epub 2011 Oct 21.
ERCP may be challenging or may fail in certain situations, including postsurgical anatomy, periampullary diverticula, ampullary tumor invasion, and high-grade strictures.
To report a large experience with EUS-guided anterograde cholangiopancreatography (EACP) to facilitate ductal access or perform direct EUS-guided therapy in patients with postsurgical anatomy or failed ERCP.
Retrospective cohort study.
Tertiary referral center.
Ninety-five consecutive patients with failed ERCP or inaccessible papilla over a 4-year period.
EACP techniques involved ductal puncture and ductography, followed by either guidewire advancement for rendezvous ERCP in patients with duodenoscope accessible papilla or direct drainage in altered anatomy. For failures, crossover to the alternate EACP technique was performed when appropriate.
Technical success rates and complications.
EACP procedures were attempted in 95 of 2566 ERCP procedures (3.7%). EUS-guided cholangiography (n = 70) and pancreatography (n = 25) were successful in 97% and 100%, respectively. EUS-guided rendezvous ERCP was successful in 75% of biliary procedures and in 56% of pancreatic procedures. Direct EUS-guided therapy was successful in 86% and 75% of biliary and pancreatic procedures, respectively. Direct interventions included pancreaticogastrostomy (n = 10), anterograde stent across stricture (n = 10), hepaticogastrostomy (n = 8), and choledochoduodenostomy (n = 1). Ten complications (10.5%) related to EACP or subsequent rendezvous ERCP included pancreatitis (n = 5), hematoma (n = 1), bile leak (n = 1), bacteremia (n = 1), pneumoperitoneum (n = 1), and perforation (n = 1).
Single-center experience; retrospective study.
EACP complements ERCP and allows successful pancreaticobiliary therapy in a large proportion of patients with failed ERCP or difficult-to-access papilla.
ERCP 在某些情况下可能具有挑战性或失败，包括手术后解剖结构、壶腹周围憩室、壶腹肿瘤侵犯和高级别狭窄。
报告一项使用 EUS 引导的顺行胆胰管造影术（EACP）的大量经验，以帮助导管进入或对手术后解剖结构或 ERCP 失败的患者进行直接 EUS 引导治疗。
回顾性队列研究。
三级转诊中心。
4 年内，95 例 ERCP 失败或无法触及乳头的连续患者。
EACP 技术包括胆管穿刺和胆管造影，然后在十二指肠镜可触及乳头的患者中进行导丝推进以进行会师 ERCP，或在解剖结构改变的患者中进行直接引流。对于失败的患者，在适当的情况下进行交叉到另一种 EACP 技术。
技术成功率和并发症。
在 2566 例 ERCP 中尝试了 95 例（3.7%）EACP 程序。EUS 引导的胆管造影（n = 70）和胰管造影（n = 25）的成功率分别为 97%和 100%。EUS 引导的会师 ERCP 在胆道手术中成功率为 75%，在胰腺手术中成功率为 56%。直接 EUS 引导治疗在胆道和胰腺手术中的成功率分别为 86%和 75%。直接干预措施包括胰胃吻合术（n = 10）、顺行支架穿过狭窄（n = 10）、肝胃吻合术（n = 8）和胆总管空肠吻合术（n = 1）。10 例与 EACP 或随后的会师 ERCP 相关的并发症（10.5%）包括胰腺炎（n = 5）、血肿（n = 1）、胆漏（n = 1）、菌血症（n = 1）、气腹（n = 1）和穿孔（n = 1）。
单中心经验；回顾性研究。
EACP 补充了 ERCP，并允许在很大一部分 ERCP 失败或难以触及乳头的患者中进行成功的胰胆治疗。
